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OBJECTIVE: To assess the long-term clinical and economic impact of integrated pump/CGM technology therapy as compared to multiple daily injections (MDI), for the treatment of type 1 diabetes (T1D) in Colombia. METHODS: The CORE Diabetes Model was used to simulate a hypothetical cohort of patients with T1D. Mean baseline characteristics were taken from a clinical study conducted in Colombia and a healthcare payer perspective was adopted, with a 5% annual discount rate applied to both costs and outcomes. RESULTS: The integrated pump/CGM improved mean life expectancy by 3.51 years compared with MDI. A similar increase occurred in mean quality-adjusted life expectancy with an additional 3.81 quality-adjusted life years (QALYs). Onset of diabetes-related complications was also delayed as compared to MDI, and mean survival time free of complication increased by 1.74 years with integrated pump/CGM. Although this increased treatment costs of diabetes as compared to MDI, savings were achieved thanks to reduced expenditure on diabetes-related complications. The estimated incremental cost-effectiveness ratio (ICER) for SAP was Colombian Pesos (COP) 44,893,950 (approximately USD$23,200) per QALY gained. CONCLUSIONS: Improved blood glucose control associated to integrated pump/CGM results in a decreased incidence of diabetes-related complications and improves life expectancy as compared to MDI. Using recommended thresholds from the World Health Organization and previous coverage decisions about health technologies in Colombia, it is a cost-effective alternative to MDI for the treatment of type 1 diabetes in Colombia.

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OBJECTIVE: In order to compare the cost and to find the cost-effectiveness ratio of 0.5 mg/day entecavir versus pegylated interferon in the suppression of the viral replication and the quality of life of chronic hepatitis B patients based on a previously developed economic evaluation by Spackman y Veenstra, we performed, previous data transferability analysis, an adaptation of the model to the Venezuelan reality. METHODS: To adapt the economic evaluation, we assumed the probabilities of transition between states, in accordance with the effectiveness reported in the original evaluation. The hypothetical cohort was based on the characteristics of patients in recent clinical trials. The model results included the cost of each treatment alternative, entecavir and pegylated interferon, as well as quality adjusted life years (QALYs) gained. RESULTS: Entecavir 0.5 mgprovides 18,25 QALYs compared with 18,12 QALYs provided by pegylated interferon. The cost per QALY was 5.257 BsF for entecavir compared with pegylated interferon whose cost ranges 6.716 y 7.358 BsF per QALY CONCLUSIONS: Entecavir 0.5 mg provides a greater amount of QALYs and a better cost-effectiveness ratio than pegylated interferon showing extended dominancy over this.

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La Sociedad Americana de Cáncer estima que se diagnosticaron 5.050 nuevos casos de leucemia mieloide crónica (LMC) en Estados Unidos durante el 2009. Cerca de 470 personas en los Estados Unidos murieron a causa de la enfermedad en 2009, con un rango de edad de 45 a 55 años, y una razón hombre - mujer de 1,4:1. Este tipo de leucemias representa entre el 15-20% de todas las leucemias, con una incidencia de 1 a 2 casos por cada 100.000 adultos. Más del 50% de los pacientes con LMC serán asintomáticos al momento del diagnóstico y tendrán una esperanza de vida del 39% comparado con la población de adultos sanos. La LMC afecta principalmente a los adultos y se asocia a una anormalidad cromosómica llamada Cromosoma Filadelfia, el cual crea un gen anormal llamado BCR-ABL, que codifica una proteína anormal llamada tirosina kinasa, y se cree que ésto produce que las células afectadas por la leucemia crezcan y se desarrollen. La enfermedad presenta tres fases: crónica, acelerada y blástica. Cada una de estas fases difiere en su tiempo de duración, presentación clínica y respuesta al tratamiento. Tanto la fase acelerada, como la fase blástica son consideradas fases avanzadas, y el 15% de los pacientes con LMC se encontraran en una de estas fases en el momento de ser diagnosticados. El imatinib es el primer inhibidor sintético múltiple de tirosin-kinasa. La unión de este fármaco se logra en los sitios de unión de ATP, de la conformación BCR-ABL kinasa inactivos, logrando una inhibición del crecimiento e induciendo apoptosis de las células que expresan esta conformación. Un 20 a 30% de los pacientes a los que se les administra imatinib presentaran resistencia. El dasatinib® (BMS-354825) es la primera terapia autorizada por la FDA como tratamiento de la LMC resistente o intolerante a imatinib.

The American Cancer Society estimates that 5.050 new cases of chronic myeloid leukemia (CML) were diagnosed in United States in 2009. About 470 persons in the United States will die of chronic myeloid leukemia in 2009, with an age range going from 45 to 55, a mean from 53 to 55, with less than 10% under 20 years, with a male to female proportion of 1,4:1. This kind of leucemia represents between 15-20% of all leukemias, with an incidence of 1 to 2 cases per each 100,000 adults. More than 50% of the patients diagnosed with chronic myeloid leukemia will be asymptomatic at the time of the diagnosis and will have a life expectancy less than 39% if they compared to healthy adults. CML affects adults principally and it is associated to a chromosomal abnormality called the Philadelphia Chromosome, which generates an abnormal gene called BCR-ABL. This gene produces an abnormal protein called Tyrosine-Kinase, believed to cause growth and development in the cells affected by the leukemia. The disease has 3 phases: chronic, accelerated and blastic. Each phase has a differ different duration time, clinical presentation and response to treatment. The accelerated phase and blastic phase are considered advanced phases, and 15% of the total patients will have reached those phases at the time of the chronic mieloide leukemia diagnosis. Imanitib is the first multiple synthetic Tyrosine Kinase inhibitor. The union of this medication to the ATP binding sites of the inactive BCR-ABL Kinase conformation achieves the inhibition of the growth and induces apoptosis of the cells that express that conformation. Approximately 20 to 30% of the patients to whom Imatinib is administered will develop resistance. Dasatinib (BMS-354825) is the first therapy authorized by the FDA as a treatment of the CML which is resistant or intolerant to Imatinib.

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Se analizan algunos temas relacionados con la selección y la construcción de los datos de costos unitarios para utilizar en análisis económicos regionales, con ejemplos ilustrativos de un análisis de la vacuna conjugada infantil antineumocócica realizado en 10 países de América Latina y el Caribe en 2006. El objetivo del análisis fue obtener un conjunto consistente de costos unitarios de recursos empleados en el tratamiento de la enfermedad neumocócica, según una bien ponderada combinación de datos publicados, tasas de reembolso, datos de cobro y nuevos métodos de determinación de costos detallados. Los pasos previos al análisis abarcaron la determinación del grado de detalle requerido, la definición del intervalo de costos de interés y la selección de conceptos de medición apropiados. Se determinó el costo detallado de los ítems mediante la descomposición de los componentes del tratamiento. Para el análisis se utilizaron los costos promedio ponderados por la población. En este informe se describen los diferentes métodos de determinación del costo empleados en el estudio y los problemas conceptuales y prácticos encontrados para su aplicación. También se identifican los posibles retos para generalizar este enfoque a otros escenarios de determinación de costos con otras enfermedades.

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Objetivo: Valorar el costo del servicio de hospitalización domiciliaria en comparación a la hospitalización institucional, teniendo en cuenta el perfil epidemiológico y los días estancia. Métodos: Estudio descriptivo, retrospectivo, longitudinal, realizado con pacientes pertenecientes a una compañía de seguros con productos como pólizas de salud y medicina prepagada, que hicieron uso del servicio de hospitalización domiciliaria e institucional en el período comprendido entre enero - diciembre del año 2007. Resultados: Se encontró que el costo de la hospitalización domiciliaria es el 18% del total del costo de la hospitalización institucional. Se evaluó la diferencia por perfil epidemiológico y por número de días estancia. Conclusiones: La hospitalización domiciliaria es una opción para disminuir el costo de la atención y permite la recuperación del paciente en su entorno.

Objective: To evaluate the cost of hospital at home compared to hospital institution, taking into account the epidemiological profile and the days stay. Methods: A retrospective, longitudinal, conducted with patients of an insurance company with products like health insurance and prepaid-medicine, which made use of hospital and institutional home for the period January to December of 2007. Results: We found that the cost of home hospitalization is 18% of the total institutional cost of hospitalization. The difference was evaluated by epidemiological profile and number of days stay. Conclusions: The home care is an option to reduce the cost of care and allows the recovery of the patient in his environment.

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OBJECTIVE: To conduct a comprehensive review of data on pneumococcal disease incidence in Latin America and the Caribbean and project the annual number of pneumococcal disease episodes and deaths among children < 5 years of age in the region. METHODS: We carried out a systematic review (1990 to 2006) on the burden of pneumococcal disease in children < 5 years of age in the region. We summarized annual incidence rates and case fatality ratios using medians and interquartile ranges for invasive pneumococcal disease (IPD) (including all-IPD and separately abstracting pneumococcal meningitis, pneumonia, bacteremia, and sepsis data), pneumonia (all cause and radiologically confirmed), and acute otitis media by age group: < 1 year, < 2 years, and < 5 years. We modeled age-specific cumulative incidence of disease obtained from standard Kaplan-Meier analysis and projected data to obtain regional estimates of disease burden. We adjusted burden estimates by serotype coverage, vaccination coverage, and vaccine efficacy to estimate the number of cases and deaths averted. RESULTS: Of 5 998 citations identified, 26 papers from 10 countries were included. The estimated annual burden of pneumonia, meningitis, and acute otitis media caused by pneumococcus in children < 5 years of age ranged from 980 000 to 1 500 000, 2 600 to 6 800, and 980 000 to 1 500 000, respectively. An estimated 12 000 to 28 000 deaths due to pneumococcal disease occur in the region annually. Pneumococcal conjugate vaccine could save 1 life per 1 100 and prevent 1 case per 13 children vaccinated. CONCLUSION: A substantial burden of pneumococcal disease in the region is potentially preventable with pneumococcal conjugate vaccines and should be considered in regional vaccine decision making. Results are limited by the very few studies, conducted in selected settings, included in this review.

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OBJECTIVE: To conduct a comprehensive review of data on pneumococcal disease incidence in Latin America and the Caribbean and project the annual number of pneumococcal disease episodes and deaths among children < 5 years of age in the region. METHODS: We carried out a systematic review (1990 to 2006) on the burden of pneumococcal disease in children < 5 years of age in the region. We summarized annual incidence rates and case fatality ratios using medians and interquartile ranges for invasive pneumococcal disease (IPD) (including all-IPD and separately abstracting pneumococcal meningitis, pneumonia, bacteremia, and sepsis data), pneumonia (all cause and radiologically confirmed), and acute otitis media by age group: < 1 year, < 2 years, and < 5 years. We modeled age-specific cumulative incidence of disease obtained from standard Kaplan-Meier analysis and projected data to obtain regional estimates of disease burden. We adjusted burden estimates by serotype coverage, vaccination coverage, and vaccine efficacy to estimate the number of cases and deaths averted. RESULTS: Of 5 998 citations identified, 26 papers from 10 countries were included. The estimated annual burden of pneumonia, meningitis, and acute otitis media caused by pneumococcus in children < 5 years of age ranged from 980 000 to 1 500 000, 2 600 to 6 800, and 980 000 to 1 500 000, respectively. An estimated 12 000 to 28 000 deaths due to pneumococcal disease occur in the region annually. Pneumococcal conjugate vaccine could save 1 life per 1 100 and prevent 1 case per 13 children vaccinated. CONCLUSION: A substantial burden of pneumococcal disease in the region is potentially preventable with pneumococcal conjugate vaccines and should be considered in regional vaccine decision making. Results are limited by the very few studies, conducted in selected settings, included in this review.

OBJETIVO: Realizar una revisión amplia de los datos sobre la incidencia de la enfermedad neumocócica en América Latina y el Caribe y proyectar el número anual de episodios de la enfermedad y de defunciones entre niños menores de 5 años de edad en la región. MÉTODOS: Se llevó a cabo una revisión sistemática (1990-2006) sobre la carga de la enfermedad neumocócica en niños < 5 años en la región. Las incidencias anuales y las tasas de letalidad se compendiaron mediante las medianas y los rangos intercuartiles de la enfermedad neumocócica invasiva (en su conjunto y por separado para meningitis, neumonía, bacteremia y sepsis neumocócicas), la neumonía (todos los casos confirmados mediante radiología) y la otitis media aguda, por grupos de edad: < 1 año, < 2 años y < 5 años. Se modeló la incidencia acumulada de la enfermedad específica para la edad mediante el análisis estándar de Kaplan-Meier y se proyectaron los datos para obtener estimados regionales de la carga de la enfermedad. Para estimar el número de casos y muertes evitados se ajustaron los estimados de la carga según la cobertura de los serotipos bacterianos, la cobertura de la vacunación y la eficacia de la vacuna. RESULTADOS: De las 5 998 referencias identificadas se seleccionaron 26 artículos de 10 países. La carga anual estimada de neumonía, meningitis y otitis media aguda causadas por neumococos en niños < 5 años varió entre 980 000 y 1 500 000, 2 600 y 6 800, y 980 000 y 1 500 000, respectivamente. Se estimó que en la región podrían morir anualmente entre 12 000 y 28 000 niños debido a la enfermedad neumocócica. La vacuna antineumocócica conjugada podría salvar una vida por cada 1 100 niños vacunados y evitar un caso de enfermedad por cada 13. CONCLUSIONES: Se podría evitar una parte substancial de la carga de enfermedad neumocócica en la región mediante la aplicación de vacunas antineumocócicas conjugadas y esto se debe tener en cuenta al tomar decisiones sobre la vacunación...

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OBJECTIVE. In Latin America and the Caribbean, routine vaccination of infants against Streptococcus pneumoniae would need substantial investment by governments and donor organizations. Policymakers need information about the projected health benefits, costs, and cost-effectiveness of vaccination when considering these investments. Our aim was to incorporate vaccine, demographic, epidemiologic, and cost data into an economic analysis of pneumococcal vaccination of infants in Latin America and the Caribbean. METHODS. We previously used a structured literature review to develop regional estimates of the incidence of disease. Cost data were collected from physician interviews and public fee schedules. We then constructed a decision analytic model to compare pneumococcal conjugate vaccination of infants with no vaccination across this region, examining only vaccine’s direct effects on children. RESULTS. Pneumococcal vaccination at the rate of diphtheria-tetanus-pertussis vaccine coverage was projected to prevent 9 500 deaths per year in children aged 0 to 5 years in the region, or approximately one life saved per 1 100 infants vaccinated. These saved lives as well as averted cases of deafness, motor deficit, and seizure result in 321 000 disability-adjusted lifeyears (DALYs) being averted annually. At vaccine prices between US$5 and US$53 per dose, the cost per DALY averted from a societal perspective would range from US$154 to US$5 252. CONCLUSION. Pneumococcal conjugate vaccine was highly cost-effective up to $40 per dose. Introduction of pneumococcal vaccine in the Latin American and Caribbean region is projected to reduce childhood mortality and to be highly cost-effective across a range of possible costs.

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OBJECTIVE: In Latin America and the Caribbean, routine vaccination of infants against Streptococcus pneumoniae would need substantial investment by governments and donor organizations. Policymakers need information about the projected health benefits, costs, and cost-effectiveness of vaccination when considering these investments. Our aim was to incorporate vaccine, demographic, epidemiologic, and cost data into an economic analysis of pneumococcal vaccination of infants in Latin America and the Caribbean. METHODS: We previously used a structured literature review to develop regional estimates of the incidence of disease. Cost data were collected from physician interviews and public fee schedules. We then constructed a decision analytic model to compare pneumococcal conjugate vaccination of infants with no vaccination across this region, examining only vaccine's direct effects on children. RESULTS: Pneumococcal vaccination at the rate of diphtheria-tetanus-pertussis vaccine coverage was projected to prevent 9500 deaths per year in children aged 0 to 5 years in the region, or approximately one life saved per 1 100 infants vaccinated. These saved lives as well as averted cases of deafness, motor deficit, and seizure result in 321000 disability-adjusted life years (DALYs) being averted annually. At vaccine prices between US$5 and US$53 per dose, the cost per DALY averted from a societal perspective would range from US$154 to US$5252. CONCLUSION: Pneumococcal conjugate vaccine was highly cost-effective up to $40 per dose. Introduction of pneumococcal vaccine in the Latin American and Caribbean region is projected to reduce childhood mortality and to be highly cost-effective across a range of possible costs.

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OBJECTIVE: In Latin America and the Caribbean, routine vaccination of infants against Streptococcus pneumoniae would need substantial investment by governments and donor organizations. Policymakers need information about the projected health benefits, costs, and cost-effectiveness of vaccination when considering these investments. Our aim was to incorporate vaccine, demographic, epidemiologic, and cost data into an economic analysis of pneumococcal vaccination of infants in Latin America and the Caribbean. METHODS: We previously used a structured literature review to develop regional estimates of the incidence of disease. Cost data were collected from physician interviews and public fee schedules. We then constructed a decision analytic model to compare pneumococcal conjugate vaccination of infants with no vaccination across this region, examining only vaccine's direct effects on children. RESULTS: Pneumococcal vaccination at the rate of diphtheria-tetanus-pertussis vaccine coverage was projected to prevent 9 500 deaths per year in children aged 0 to 5 years in the region, or approximately one life saved per 1 100 infants vaccinated. These saved lives as well as averted cases of deafness, motor deficit, and seizure result in 321 000 disability-adjusted life years (DALYs) being averted annually. At vaccine prices between US$5 and US$53 per dose, the cost per DALY averted from a societal perspective would range from US$154 to US$5 252. CONCLUSION: Pneumococcal conjugate vaccine was highly cost-effective up to $40 per dose. Introduction of pneumococcal vaccine in the Latin American and Caribbean region is projected to reduce childhood mortality and to be highly cost-effective across a range of possible costs.

OBJETIVO: En América Latina y el Caribe, la vacunación sistemática de niños contra Streptococcus pneumoniae podría requerir inversiones considerables de los gobiernos y organizaciones donantes. Al evaluar estas inversiones se requiere información sobre los posibles beneficios sanitarios, costos y rentabilidad (relación costo-efectividad) de la vacunación. Se presenta un análisis económico de la vacunación infantil antineumocócica en América Latina y el Caribe a partir de la información de la vacuna y de datos demográficos, epidemiológicos y de costos. MÉTODOS: Se realizó una revisión bibliográfica estructurada previa para llegar a estimados regionales de la incidencia de la enfermedad. Los costos se tomaron de entrevistas a médicos y tarifas públicas. Se construyó un modelo analítico de decisión para comparar la vacunación de los niños de esta región con la vacuna antineumocócica conjugada y la no vacunación, tomando en cuenta solamente el efecto directo de la vacuna en los niños. RESULTADOS: Se proyectó la vacunación antineumocócica con las tasas de cobertura de la vacuna contra la difteria, el tétanos y la tosferina para prevenir 9 500 muertes anuales en menores de 5 años en esta región, o aproximadamente 1 vida salvada por cada 1 100 niños vacunados. Las vidas salvadas y los casos prevenidos de sordera, trastornos psicomotores y convulsiones equivalen a evitar anualmente 321 000 años de vida ajustados por incapacidad (AVAD). A un precio de la vacuna de US$ 5,00 a US$ 53,00 por dosis, el costo por AVAD evitado desde el punto de vista de la sociedad sería de US$ 154,00 a US$ 5 252,00. CONCLUSIONES: La vacuna antineumocócica conjugada fue altamente rentable hasta un precio de US$ 40,00 por dosis. La introducción de esta vacuna en América Latina y el Caribe puede reducir la mortalidad infantil con una alta rentabilidad en un amplio espectro de posibles costos.

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